RÉSUMÉ
Background: Hormonal suppression decrease pain and reduce endometrioma size in women with endometriosis. There are medications like cabergoline which reduce inflammation associated with endometriosis but do not prevent ovulation. Hormonal suppression followed by cabergoline may allow pregnancy in women with endometriosis. The objective of the study was to assess and compare the efficacy of medical versus surgical management in infertile women with endometriosis.Methods: A patient preference clinical trial was carried out on 20 women who wish pregnancy and has sonographic evidence of endometrioma and pain. They were counseled adequately about the advantages and disadvantages of surgical and medical management of endometriosis with infertility and were asked to make a choice. The interventions were applied according to patient preference. The interventions were i) dienogest for 3 months when cyst size ?5 cm and letrozole plus norethisterone for 6 months when cyst size > 5 cm followed by cabergoline 0.5 mg twice weekly for 6 months, plus timed intercourse and ii) laparoscopic surgery followed by expectant management or ovarian stimulation with or without intrauterine insemination. The women were followed up for results.Results: A total of 18 participants opted for medical management and only 2 participants for surgery. All participants given medical management had reduction of pain, and all except one had reduction of cyst size. Pregnancy occurred in 2 out of 14 (14.3%) participants given medication. One woman with surgery had persistence of pain and recurrence of cyst. No one having surgery got pregnant during the study period.Conclusions: The infertile women with endometriosis prefer medical management over surgery. The medical management may be a better option for infertile women with endometriosis who do not plan in vitro fertilization in near future.
RÉSUMÉ
Background: Poly cystic ovarian syndrome (PCOS) is a complex multifactorial disorder, affecting millions of women worldwide. Kisspeptin, a hypothalamic peptide encoded by the KISS1 gene, is widely reported as a key factor in the regulation of luteinizing hormone (LH)/follicular stimulating hormone (FSH) secretion, which may be potentially involved with the development of PCOS. The aim of the study was to estimate the serum kisspeptin level in PCOS patients and evaluate the association of kisspeptin with other biochemical, and hormonal parameters in women with PCOS.Methods: This case-control study was conducted at the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from August 2020 to July 2021. A total of 90 patients between age 18-30 years were enrolled in this study. Data was collected on variables of interest by using the structured questionnaire designed for interview, observation, clinical examination, and biochemical investigation of the patients and analyzed by using the t-test, non-parametric test (Mann-Whitney U test) and chi-square test as appropriate.Results: We found no significant difference between PCOS & control group, but acanthosis nigricans (AN), waist hip (W:H) ratio were statistically significant in PCOS group. We found serum LH (11.98±6.29 mIU/ml), LH: FSH (1.71±0.92), AMH (10.09±3.8 ng/ml), fasting insulin (26.53±28.34 µU/ml), ovarian volume (16.91±4.57), was significantly higher in PCOS patients. Kisspeptin value in PCOS patients was 85.92±56.59 pg/ml and control group was 63.74±43.16 pg/ml. In the PCOS group, there was a positive correlation between kisspeptin and LH, AMH, and ovarian volume.Conclusions: Serum kisspeptin levels were similar in women with or without PCOS but positively correlated with ovarian volume, serum LH and AMH in PCOS patients.
RÉSUMÉ
Background: Poly cystic ovarian syndrome (PCOS) is a complex multifactorial disorder, affecting millions of women worldwide. Kisspeptin, a hypothalamic peptide encoded by the KISS1 gene, is widely reported as a key factor in the regulation of luteinizing hormone (LH)/follicular stimulating hormone (FSH) secretion, which may be potentially involved with the development of PCOS. The aim of the study was to estimate the serum kisspeptin level in PCOS patients and evaluate the association of kisspeptin with other biochemical, and hormonal parameters in women with PCOS.Methods: This case-control study was conducted at the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from August 2020 to July 2021. A total of 90 patients between age 18-30 years were enrolled in this study. Data was collected on variables of interest by using the structured questionnaire designed for interview, observation, clinical examination, and biochemical investigation of the patients and analyzed by using the t-test, non-parametric test (Mann-Whitney U test) and chi-square test as appropriate.Results: We found no significant difference between PCOS & control group, but acanthosis nigricans (AN), waist hip (W:H) ratio were statistically significant in PCOS group. We found serum LH (11.98±6.29 mIU/ml), LH: FSH (1.71±0.92), AMH (10.09±3.8 ng/ml), fasting insulin (26.53±28.34 µU/ml), ovarian volume (16.91±4.57), was significantly higher in PCOS patients. Kisspeptin value in PCOS patients was 85.92±56.59 pg/ml and control group was 63.74±43.16 pg/ml. In the PCOS group, there was a positive correlation between kisspeptin and LH, AMH, and ovarian volume.Conclusions: Serum kisspeptin levels were similar in women with or without PCOS but positively correlated with ovarian volume, serum LH and AMH in PCOS patients.